Prostate Medication Refill Request Form

Managing prostate health requires consistent medication and regular monitoring. This Prostate Medication Refill Request Form simplifies the process for urology practices and healthcare providers by combining prescription refills, PSA level tracking, urinary symptom assessment, and appointment scheduling into a single, patient-friendly experience.

Designed specifically for urology clinics, men's health centers, and primary care providers managing prostate conditions, this template helps patients request refills for medications like finasteride, dutasteride, tamsulosin, or alpha-blockers while providing essential health updates. The built-in International Prostate Symptom Score (IPSS) assessment allows physicians to monitor treatment effectiveness and adjust care plans accordingly.

With Paperform's conditional logic, the form intelligently adapts based on patient responses—flagging concerning PSA increases, severe urinary symptoms, or medication side effects for immediate clinical review. Healthcare teams can route urgent cases differently than routine refills, ensuring appropriate care without unnecessary delays.

Integration with your practice management system, EHR, or pharmacy software through Stepper means refill requests flow directly into your existing workflow. Automatically notify pharmacies, update patient records, schedule follow-up labs, or send appointment reminders—all triggered by form submission.

For practices looking to streamline administrative tasks while maintaining quality care, this template reduces phone calls, improves medication adherence tracking, and ensures critical health indicators are monitored at every refill request. Paperform's HIPAA-alternative security features and professional design make it a trusted solution for healthcare providers serving patients with benign prostatic hyperplasia (BPH), prostatitis, or prostate cancer.